Monday
Sep292014

Hospital Nutrition

Nutrition supplementation in hospital works

My belief in nutrition and supplementation was recently vindicated after I had a small accident and had to go into hospital a week later. Of course I took lots of good nutrition, did all the right things and walked out of the hospital 5 hours later. I had totally recovered in 3 days. What surprised me was that a few people came up and told me how long others were in pain for and still recovering 5 weeks later. I checked and the recovery time is much more than a few days. So what is different?

There are now a growing number of studies showing that supplementation in hospital prior to and after surgery not only speeds up recovery, saving a lot of pain and suffering and tens of thousands of dollars in hospital per person, but also assists post-operative healing and recovery outside the hospital. Benefits reported in the scientific literature include reduced inpatient episode cost, complication rates, depressive symptoms, and readmission rates, and improved lean body mass recovery and so much more. In fact the nutritional status of patients on admission into hospital is a good predictor of their length of stay.1 In one study, patients receiving nutrient supplementation had 70% fewer infections, fewer complications and accelerated recovery compared with controls.2

A number of studies have shown a benefit for supplementing patients with fractures. In a study of 59 elderly patients (mean age 82) with femoral neck fractures, 27 received an oral nutrition supplement daily while 32 patients acted as controls.3 Clinical outcomes were significantly better in the supplemented group, with 56% having favourable outcomes, including reduced rates of complications and deaths, compared to 13% in controls. That is a big difference.

In a study of patients who had undergone gastrointestinal surgery, patients treated with oral supplements had a significantly improved nutritional intake and lost less weight compared with control patients.4 Supplemented patients maintained their handgrip strength, whereas control patients showed a significant reduction in grip strength. Subjective levels of fatigue increased significantly above preoperative levels in control patients but not in the supplemented group. Twelve patients in the control group developed complications, compared with four in the supplemented group. A 300% increase in complications for the non-supplemental group.

One study looked at patients from a geriatric acute care hospital, aged 75 years or older without malignant disease. In the supplemented patients with good acceptance, a median improvement of 20 points was observed between admission and discharge; subjects enjoyed a further improvement of five points at home in functional status based on the Barthel Activities of Daily Living (ADL) score.5 In the supplement group, the proportion of independent patients (>65 points) increased continuously, from 36% at admission to 63% (compared to 19% in the control) at discharge, then to 72% (compared to 39% in the control) after six months. Sixty-four percent of the patients in the supplement group improved during hospitalization, compared to 23% in the control group. Imagine the reduction in pain and suffering, not to mention the economic benefits by spending a few dollars a day supplementing.

In a study of 101 patients, of which 52 were randomised to a supplement group, anthropometry, grip strength and quality of life were similarly significantly different between groups.6 Fewer patients in the supplement group (seven out of 52) required antibiotic prescriptions compared with the control group (15 of 49). Postoperative nutritional supplementation improved nutritional status and quality of life and lessened morbidity in these patients. In a study of 116 undernourished patients admitted to a stroke service, patients receiving intensive nutritional supplementation improved more than those on standard treatments on measures of motor function. A higher proportion of patients who received the intensive nutritional supplementation went home compared to the control.

In a prospective, randomised, double-blind, placebo-controlled study, patients scheduled to undergo coronary artery bypass were selected to receive an oral immune-enhancing nutritional supplement or a control for a minimum of five days. For those given the supplement, immune system indicators improved and delayed-type hypersensitivity response improved preoperatively and remained better until hospital discharge.7 The researchers concluded that intake of an oral immune-enhancing nutritional supplement for a minimum of five days before surgery can improve outlook in high-risk patients who are undergoing elective cardiac surgery.

In a study of prostate cancer survivors, the group that included a change in lifestyle and nutritional supplementation with vitamins C and E, selenium and omega 3 oils had significant improvements in every parameter measured. Operations were avoided, PSA (prostate-specific antigen) declined compared to an increase in the control group; all indicators were positive including the ability of the treatment group to defend against cancerous cells.8

In HIV infection, deficiencies of specific nutrients have been shown to be associated with more frequent opportunistic infections, faster progression of disease and higher AIDS mortality.9,10 Improvements were reported in immune responses indicated by an increase in CD4 cell count in HIV-infected patients receiving micronutrients. Specific nutritional supplements, designed to raise patients’ glutathione peroxidase levels, appeared to be able to significantly increase CD4 cell count recovery in HIV-infected patients receiving no other medications.12 This increase in CD4 cell count was associated with an improvement in quality of life and an increase in body weight. A multivitamin supplement that included vitamin C significantly slowed the onset of AIDS and provided an “effective, low-cost means of delaying the initiation of antiretroviral therapy in HIV-infected women.” The total cost of the treatment was estimated by the researchers to be about $15 per year.11

As the population ages and we see increased demand for hospital beds, a number of hospitals around the world are using supplements to speed the recovery of patients. In addition, studies are showing that supplements can reduce the use of expensive medications. Information from the British Association for Parenteral and Enteral Nutrition (BAPEN) indicated that some 25% of patients admitted to hospitals and care homes were at risk of malnutrition.13 The group collected data from 11,600 patients and found that, in hospitals, those under 30 years of age had a 27% risk of malnutrition compared with a 34% risk in over-80s. In care homes, those under 70 had a 26% risk compared to 32% for those over 80. In a ten-year follow-up of a group of successfully ageing elderly people in Italy, at the beginning of the study 44% of the men and 60% of the women were already deficient compared to the lowest common denominator of the Recommended Daily Intake.12 After a decade, the prevalence of vitamins B2 and A deficiencies rose to 50% of the sample. Vitamin C deficiencies rose in a decade from three percent to six percent in men and from 2.3% to 4.5% in women. These were deficiencies below the RDA/RDI, imagine how many were below optimal levels of nutrients. The study concluded that multivitamin supplementation may be necessary, even in healthy individuals, to ensure an adequate micronutrient intake in the elderly. According to human studies, changes in immunity associated with ageing are related to oxidative stress, free radical and pro-inflammatory cytokine production that increase with age14 and all of these are influenced through nutrition and even the healthy ageing need to supplement.

A number of studies have shown that vitamin D deficiency is linked to the immunological status in intensive care unit patients and that vitamin D supplementation can improve patient's immunological status and health outcomes. Studies also demonstrate that vitamin D deficiency is very common in intensive care unit patients, and it is significantly associated with longer discharge times, increased organ failure, and a higher number of infections in intensive care 15. Vitamin D deficiency in intensive care is correlated with many infectious diseases 15 and susceptibility to respiratory infections such as infection by the tuberculosis bacteria (Mycobacterium tuberculosis) 16.

It seems that poor nutrition is a major problem in all areas of hospitals and health care, even trauma care. In a recent study of trauma patients inadequate nutritional status was found to be associated with reduced wound healing partly by means of oxidative stress and inflammation. Thus, adequate nutritional measures are strongly recommended to trauma patients 17.

With the escalating costs of health care and the hospital system one would think hospitals and medical insurance companies would inform patients of this research and encourage them to improve their nutritional status through supplementation so they can save money, pain and suffering and even save lives. Supplementation saves lives.

  1. 1. Robuck and Fleetwood 1992
  2. 2. Daly et al. 1992
  3. 3. Delmi et al. 1990
  4. 4. Keele et al. 1997
  5. 5. Volkert et al. 1996
  6. 6. Beattie et al. 2000
  7. 7. Tepaske et al. 2001
  8. 8. Ornish et al. 2005
  9. 9. Semba and Tang 1999
  10. 10. Tang et al. 1996
  11. 11. Fawzi et al. 2004
  12. 12. Namulemia et al. 2007
  13. 13. Victor and de la Fuente 2002
  14. 14. Elia et al. 2007
  15. 15. Higgins et al. 2012
  16. 16. Hughes et al. 2009
  17. 17. Blass et al . 2013

 

Sunday
Sep282014

Doctors don't study nutrition

What your Doctor doesn’t know might be killing you.

Acknowledgements.  Peg Davies, Kellie Reid, Haidi Jurd, Cleve Etherington, Gilleon Wake

“Never confuse education with intelligence.” – Albert Einstein

I met two couples recently one in their 60s and the other in their late 70’s. One couple in their 60’s was on more than 12 medications between them each day including statins, beta blockers, warfrin, asprin and so on. It cost them around $25 a week as most of the drugs were subsidized and the doctor said they were doing well. They complained of constant fatigue, muscle and joint pain, memory problems, severe bruising, hard to get out of bed and hard to sleep at night and long bouts of negative thoughts and depression. They had also just been diagnosed as pre diabetic but the doctor said it was ok and normal at their age. This couple underwent half a dozen medical procedures a year which was only a minimal cost to them so they felt pretty lucky.

The other couple were in their late 70’s took no medication were active for 60 minutes each day, ate a lot of home cooked meals with fish, fresh salad and fruit. They took around 10 supplements a day and literally had no health complaints. They had 2 grams of vitamin C, 3 grams of omega 3 oils, a couple of digestive enzymes and some apple cider vinegar with most meals, a couple of teaspoons of super green powder and a multi vitamin mineral mix each day. It cost them around $25 a week and the doctor said they were wasting their money. This couple visited the doctor once a year for a regular check up and each year refused to take medication “because it might help”.

Unfortunately the medical and health care system in Australia and the US is not only letting the public down but are seriously misleading them and putting them at risk. We are constantly reminded to go see our GP for advice on health yet most of our GP’s are not trained in health. This is not a criticism of GP’s, as they have the best intentions in the world and we have the best doctors in the world for acute illness like burns, breaks and bacteria but unknown to the public our doctors receive almost no training in nutrition, lifestyle, environmental or preventative medicine. I have a number of doctors as friends and I personally know dozens of doctors who agree with me and have encouraged me to get this information out to the public.  They are however simply victims of a larger system that encourages excessive treatment and the overuse of dangerous and expensive drugs.

Our system appears to be run by large vested interests who make more money from being sick and treating symptoms for a lifetime than curing patients. We treat many conditions with drugs which could be resolved much cheaper, simpler and much quicker with no negative side effects through nutrition and lifestyle interventions. Unfortunately what your doctor doesn’t know can hurt you. The work of professor Dean Ornish at Berkley University who has published research showing you can reverse arterial plaque instead of a high risk, expensive operation costing tens of thousands of dollars and drug treatment for the rest of your life. His treatment is so well recognized that his program receives a medicare rebate in the US. One success of the program was Bill Clinton who literally got sick of having high risk heart operations every two years to reduce his arterial plaque and his risk of heart attack. Professor Dean Ornish has also shown the same program reverses prostate cancer and many other chronic conditions. Since then I have seen many chronic health conditions be reversed with simple nutrition and lifestyle changes, including reversing MS and diabetes type 2.

Millions of people in every western country suffer illnesses caused by lifestyle and environmental  factors which accounts for up to 80% of health care costs 1. It is well documented that dietary and lifestyle choices are a major factor in preventing, managing and treating chronic health conditions such as obesity, heart disease, stroke, obesity, hypertension, diabetes and cancer 2,3,4,5. In addition to managing obesity and preventing major diseases, optimising nutrition is known to improve outcomes in a variety of health specialties; from elderly care to orthopaedics 2,6. Nutrition and lifestyle are the most controllable risk factor affecting long‑term health and the influence of dietary risk factors should be understood by primary care providers 7. Good nutrition is a major component to enjoying good health.

There is no doubt that health professionals, such as General Practitioners (GPs), play a vital role in health promotion and are viewed as an important source of health information by patients and the community 5,8,9,10,11. Studies show that 80 -90% of the public consult their GPs in any one year. According to the Australian Medical Association (AMA) appropriate nutrition is the key to the prevention of malnutrition, overweight and obesity and is urgently required from health, social and economic perspectives 12. Most GP’s agree that nutritional training is important and should be an integral part of the treatment for their patients. Nutritional advice from doctors and other health workers is held in high regard by the general public. It is important, therefore, to ensure that the advice given is sound and safe. GPs are seen by patients as the major and most reliable source of nutrition guidance 13,14. In one study seventy six per cent of the doctors agreed that nutrition greatly influenced health status, and 96% agreed that doctors’ attitudes and advice influence their patients’ diet. Overall, family physicians had positive attitudes toward the potential effects of nutrition counseling on patient behaviour, and they believed that most of their patients would benefit from nutrition counseling. Despite the significance of nutrition and lifestyle advice GP’s around the world are inadequately prepared to give nutritional and lifestyle advice. A study of health system performance in Australia, Canada, New Zealand. the United Kingdom and the United States found that between one‑half and three‑quarters of patients in the five nations said they had not received advice or counselling on weight, nutrition or exercise from their GPs 15. In an Australian study only 38% of Australian adults reported having received any advice from their GPs on weight, nutrition and exercise 15.

Barriers to providing nutritional information to patients in Australia include lack of time and compensation consistent with studies from other countries 16. With most GP visits taking fifteen minutes or less and often many health issues and disease processes may need to be addressed in that time 16. The inability for GPs to obtain nutritional materials to refer to and give to patients is also a barrier to improving nutritional advice offered to the public 17. In a study which nutritional resource manuals were given to GPs, it was reported that the GPs confidence in their ability to provide specific nutritional information and recommend specific dietary changes improved considerably 18. Further to this, the number of GPs who used patient nutrition education materials significantly improved. This shows the importance of GPs having access to current nutritional materials to enhance their knowledge and provide sound advice to patients. Of great concern in another study 40 percent of GPs said their nutritional information came from magazines and newspapers 19 which are extremely unreliable and biased.

By far the biggest barrier however is that our primary health care professionals get very little if any nutritional training in their original studies. Ninety-eight percent of medical schools report nutrition as a component of medical education. However, most schools do not have an identifiable nutrition curriculum. While there may be some hours of training devoted to biochemistry that covers some biochemical pathways and information there is virtually none devoted specifically to nutrition and disease. Teaching the role of niacin in energy production is biochemistry, not nutrition; because it says nothing about dietary needs, food composition, or clinical application 20 such as reducing conditions such as muscular weakness and fatigue, insomnia, depression, schizophrenia and managing blood cholesterol. The bulk of nutrition education continues to be taught in the basic science courses or in an integrated format; meaning that three‑quarters of the nutrition instruction in medical schools is not specifically identified as nutrition in the curriculum 20.

Nutrition training for medical students is identified as an important part of medical education by several organizations, including the American Society for Clinical Nutrition, the American Medical Student Association, and the National Academy of Sciences (NAS). However, many medical schools do not provide 25 hours of nutrition education, which is the minimum recommended by the NAS back in 1985 21. However, even 25 hours of nutritional training must be seen as inadequate given the extent of lifestyle illness and the need for good advice. One hundred hours is often seen as the level appropriate to be giving professional advice on a topic.

It is clear that GPs require a higher amount of nutrition education. Many GPs feel impeded by a lack of education in the area 14 and many acknowledge they have no or little understanding and knowledge of nutrition 22. As a result a number of surveys of found over 80% of GP’s felt they had inadequate knowledge and time to handle nutrition issues effectively in daily practice 23. Physicians surveyed persist in reported lack of confidence in basic nutrition counseling due to perceived inadequate nutrition training in medical school 20,24,25 26,27. Furthermore, over the past decade, the majority of medical student graduates, 80% or more, reported inadequate time devoted to nutrition training 16. Nutrition training is still not an integral part of either undergraduate or postgraduate medical education 1,28. But these are not new findings. Surveys from 1995 and 2005 reported practically identical barriers in GPs’ ability to deliver dietary counseling; from inadequate teaching materials to lack of nutrition knowledge 5,9,29,30 yet remains unaddressed. Unfortunately, no one profits from lifestyle medicine which is the major reason for its exclusion from medical education and practice 1.

The irony appears to have been lost on many medical institutions who have not changed or quantified nutrition curricula for decades; despite evidence indicating the high prevalence of diet as a preventative medicine, and the positive role doctors can have 20,26. This situation is contradictory to health considering nutrition is the cornerstone of overall well‑being and health, and as such, should be considered the a primary issue 32. It appears current teaching curricula within medical institutions are sacrosanct and are closely guarded by organisers, whether it be due to their own self‑importance, vested interests or ignorance making the addition of new lectures or course material (e.g., nutritional science) incredibly difficult to implement 27.

Ironically patients view doctors as experts in all areas of health, nutrition included, and may seek their advice. There is a large gap in lifestyle medicine training for those enrolled in all levels of medical education; and hence, the missed opportunity for increased quality of life for many patients.

For most GPs and health professionals nutrition is not a core skill and in situations where some training has been provided, it has often been driven by the personal enthusiasm of the individual. In Australia a group of GPs, The Australasian College of Nutritional and Environmental Medicine (www.ACNEM.org) run courses on nutritional and environmental medicine for GP’s. However, family doctors who received expert nutritional training could treat their patients more professionally than those who did not receive such training 33. Similarly, awareness of nutritional issues is left to the interest of the medical student to incorporate into their education 22 but if too much interest is shown it is squashed out of them.

Despite the obvious economic and health advantages of lifestyle medicine and nutrition counseling, and overall lack of emphasis on preventative medicine in primary care we continue to focus on the wrong end of health 15. Providing personalized lifestyle medicine to all patients diagnosed with the top five chronic diseases - cardiovascular disease; diabetes; metabolic syndrome (obesity); prostate cancer; and breast cancer; could see a reduction in health care expenditures of around $930 billion dollars over five years, in the U.S. alone 1. In addition, if lifestyle medicine was to be practiced on a global scale, better health and improved quality of life across entire populations, could only lead to greater productivity, and far less pressure on struggling health care systems 1,34.

If GPs are to play a significant role in reducing the incidence of chronic illness and disease today, it is imperative that their nutrition and lifestyle medicine training be comprehensive, timely, and most importantly – ongoing. We need to move from disease management to preventative action 1,34,35.

  1. 1. Hyman et. al. 2009
  2. 2. Hankey et. al. 2004,
  3. 3. Sydney ­Smith. 2006,
  4. 4. Post et. al. 2010,
  5. 5. Paneiro et. al. 2005
  6. 6. Leslie and Thomas 2009
  7. 7. Warber et al. 2000
  8. 8. Elley et. al. 2007;
  9. 9. Pavlekovic and Brborovic 2005;
  10. 10. Sacerdote et. al. 2006
  11. 11. Achhra 2009;
  12. 12. AMA, 2009
  13. 13. McCallum, 2005,
  14. 14. Maiburg et al. 2004
  15. 15. Shoen et. al. 2004
  16. 16. Wynn et al 2010
  17. 17. Moore Kenner et al. (1999
  18. 18. Richards and Mitchell, 2001
  19. 19. liaslam (2007
  20. 20. Adams et at (2006
  21. 21. Taren et al 2001
  22. 22. Jackson. 2001
  23. 23. Helman, 1998
  24. 24. Young et al ,
  25. 25. Tanis et al 2006, 
  26. 26. Spencer et al, 2006;
  27. 27. Walker, 2003,
  28. 28. Bas et. al. 2003;
  29. 29. Hiddink et. al. 1995;
  30. 30. Kushner 1995;
  31. 31. Inciro et al. (2005
  32. 32. Nicholas et at, 2003
  33. 33. Lazarus (1997
  34. 34. Riley 2010
  35. 35. Cole and Frautschy 2010

 

 

Sunday
Sep282014

Medicine has become dogma

Hippocrates said “There are, in effect, two things: to know and to believe one knows. To know is science and to believe one knows is ignorance.”

Unfortunately most of modern medicine has become dogma. “Dogma” is any belief that is held stubbornly. When you repeat something over enough times it becomes a belief. It is repeated in the papers and all media messages, sent to doctors, etc.

Medicine prides itself on being a science, however it is not. Science used correctly can be a marvellous thing. The role of science is to observe, explore, clarify, ask questions, form an hypothesis and have open debate. Most people don’t understand that science is based on hypothesis, not fact. A theory is proposed and it is supported or proven wrong. In medicine we confuse hypotheses with facts. All that information about cholesterol being a killer is an hypothesis or that depression is caused by low levels of serotonin is an hypothesis. They are not facts. And when enough evidence accumulates against them they are disproved unless, like today, there is too much drug money involved. It is upsetting to learn that medicine has pursued a certain direction for decades based on hypothesis that has been shown to be wrong from the onset particularly when theories are inaccurate and disproved and there are life-threatening and tragic consequences.

Medicine is riddled with major findings that have blocked the advancement of health. Back in the 1940s Oxford University scientist Hugh Sinclair realised that omega 3 fatty acids were good for us and that the Inuit (native population) ate vast amounts of fat yet hardly ever suffered from heart disease. He believed this was due to the protective effect of one fat, omega 3, found in oily fish. However, this was too controversial and he was ridiculed and lost his post at the university. Undeterred, he continued to study omega 3 and put himself on an “Eskimo diet” for 100 days; he ate nothing but seal blubber and fish. It took nearly 40 years for this information to be recognised by the mainstream establishment, as all fats were considered “bad.” Now we know that fish oils are associated with reducing many major diseases including CVD and some cancers.

Another example is the debate on folate, which lasted for decades. Observational studies, in vitro, animal and epidemiological studies clearly demonstrated the benefits of folate to reduce neural tube defects in newborns dating back to the 1960s. The authorities argued in the animal studies that we are not rats, and in regard to the epidemiological studies that you cannot confuse correlation with causation, and so nothing was done. Until the bulk of the evidence became overwhelming and everyone thought it a good idea all of a sudden. Foods were fortified and those in the mainstream patted themselves on the back for their brilliant insight. These were the same authorities who resisted the information and change for nearly 30 years while thousands of people suffered. Fortunately midwives and naturopaths have been recommending folate to pregnant women since the 1950s.

Over-the-counter medication for ulcers and stomach complaints accounted for most drug sales in the 1980s and 90s, until dogma was overwhelmed with science. Robin Warren and Barry Marshall were the joint winners of the Nobel Prize in Physiology or Medicine for the discovery that gastritis and peptic ulcers arise from an infection of the stomach caused by the bacterium Helicobacter pylori. However, it took 20 years for the two researchers to overturn established medical dogma and revolutionise the treatment of peptic ulcers and only when they put their own lives on the line. Warren first discovered the role of Helicobacter pylori in 1979, “But trying to convince other people of that was impossible,” he stated. Orthodox medical teaching at the time was that bacteria did not grow in a normal stomach. However, as Warren wrote in the 2002 book Helicobacter Pioneers, “I preferred to believe my eyes, not the medical textbooks or the medical fraternity.” While Marshall was able to convince the scientific microbiologists as they had no dogma to overcome about the causes of gastritis and peptic ulcers, the wider medical community remained hard to convince. Even the first major publication of their results, in the journal Lancet in 1984, was almost impossible to get published. The editors, Marshall recalls, found it difficult to find reviewers who could agree the paper was important, general, and interesting enough to be published.

In 1984, in an act born out of frustration, Marshall deliberately infected himself by drinking a solution swimming with the bacterium. But many clinicians still remained unmoved. It wasn’t until the early 1990s that the findings of Marshall and Warren became impossible to ignore, at which point pharmaceutical development and clinical practice underwent a shift toward eradication of H pylori to treat ulcers instead of over treatment with over-the-counter drugs and poor advice. They won the Nobel Prize for their work a decade later and helped millions of people around the world.

Our health system is badly broken. It does not need a touch up here or there or a few bandaids; it needs to be rewritten and reinvented. It is just not working. We have a collective conditioning that is failing. We continue to spend more and more money on a drug-based medical system and we are just getting sicker and sicker and dying from avoidable lifestyle diseases more frequently than ever before. The simple fact is that countries that are less developed and spend the least amount on pharmaceuticals have the longest lives, and highest health and quality of life with less chronic illness without drugs and processed lifestyles. This should ring warning bells everywhere. The countries that spend the most money on health have the sickest populations.

By not treating the illness, we get into a vicious cycle of prescription drug dependence, in which people begin with one drug then another, then one to manage the side effects of the first and, within a few years, may be on three, four, five or even more drugs. Many people are now on multiple drugs and have never felt worse. It is likely that all they had in the beginning was normal. They have gone from being normal to being caught in a cycle of pharmaceutical drug addiction because they trusted their doctors who put the fear of fire and brimstone in them if they did not take the drug. Fortunately many of these people come off their drugs when we show them the facts and they find a doctor who understands what good health means. There are also many doctors who refuse to use these drugs.

It is time for the medicine industry to stop wasting money and resources on useless research and to adopt commonsense strategies that will save lives.

In all Western nations, based on just raw statistics, the three biggest killers in order are: cardiovascular disease, cancer and the medical system. A sobering note is that very conservative figures report more than 100,000 people in hospitals in the U.S. die as a result of the medications they are taking, one million people are hospitalised and 2.2 million people have severe and often permanent disabilities each year from the side effects of medications in the U.S. The numbers are likely to be much higher than this, so if your doctor says not to worry, it is time to get another doctor. A more recent study found one in seven people in hospitals have adverse drug reactions.

However, if one looks deeper one can see that the medical system is the single biggest killer in our society and far outweighs either cancer or CVD. Drugs are the leading killer in Western society. Not only do they kill some half a million every year directly but also they indirectly sentence millions more. The false hopes promised by pharmaceutical companies often result in patients not taking any other steps that could actually save their lives (besides taking a pill that may or may not help at all). The dependence on a self-serving industry to deliver good health outcomes means interventions such as stress relief, exercise or promotion of dietary strategies are ignored or relegated to the “too hard” basket. It is much easier taking a pill; this does not serve the interests of the population.

The four different types of deaths caused through the medical system are:

1.   Adverse reactions to drugs;

2.   Adverse reactions to drugs that lead to an increase in other diseases but are reported as the new disease (statin drugs increase a persons risk of Alzheimer’s or diabetes), which go unreported as a death caused by drugs;

3.   The adverse reactions of drugs that don’t go reported that have negative impacts on the quality of our lives such as energy and pain levels which stop us from being active and taking care of ourselves; and

4.   The disempowerment of the medical system that fools people into believing that many of the drugs used to treat chronic illness work. This misinformation also includes the absence of information on what people can do to take care of their own health that really does work instead of drugs.

Each extra drug that is taken virtually doubles the risk of serious side effects and death. It does not just add onto the risk, it multiplies the risk. Unfortunately recent observations and research shows pharmaceutical drug use on the rise. The latest research shows 70% of Americans are taking at least one prescription drug, and more than half are taking two.  Twenty per cent—or one in five—Americans are taking five or more drugs regularly and the average 70-year-old is taking seven different prescription medications. The same drug use patterns are likely in Australia, New Zealand, the UK and other Western nations.

One person I know started on statins to lower cholesterol then was put on seven pharmaceutical drugs—half of them to manage the side effects of the other drugs. He then had a heart attack, which was supposed to be prevented, and is now on 13 tablets a day. And the specialists (all four of them) put the fear of death into him if he should not take one of them, but warned him against nutrition. In fact one specialist said it was like a stack of champagne glasses: if you take one out the rest will collapse. What utter rubbish. The specialist has absolutely no idea about the drug interactions and side effects and even less about nutrition. In fact that same person has now been told he has a failing liver and kidney.

All medications have serous side effects, some of them more deadly than the illness they are purporting to treat. Clinical trials are designed to show that a drug is safe and effective. But even the largest trials can’t identify unusual or even dangerous side effects experienced by only a tiny proportion of those people taking the drug. They also aren’t designed to study how drugs interact with other drugs, for example antidepressants called SSRIs interact with a common blood pressure medication to significantly increase the risk of a potentially deadly heart condition. Nor are they designed to determine long-term side effects.

Wednesday
Jul302014

Blood pressure

High blood pressure is an important risk factor for cardiovascular disease, contributing to about 50% of cardiovascular events worldwide and 37% of cardiovascular-related deaths in Western populations. In Australia around 33% of adults over 20 years of age have hypertension and is defined as having a blood pressure reading of above a safe threshold; what is being measured is the pressure of the circulating blood upon the walls of blood vessels. Commonly this threshold is referred to as a systolic (maximum) blood pressure of 140mm Hg and a diastolic blood pressure of 90mm Hg (minimum). Hypertension itself is not a disease but a condition or an indicator of increased risk of cardiovascular disease including coronary heart disease, myocardial infarction (heart attack) or stroke.

Perhaps the best way to look at blood pressure and the plaque in the arteries (atherosclerosis) is through water hydraulics or, even better, the water hose in your garden. The three main components of our vascular system we are concerned with are the pump (heart), pipes (arteries) and feedback valve (kidneys). In your garden there are a few major reasons why the pressure in your water pump increases. If there is not enough water in the pump and pipes or, related to this, the water is too thick. Or the pipes are blocked or too rigid. In your arteries, if you have not consumed enough good clean alkaline mineralised water you literally do not have enough liquid in your heart, arteries and veins to get around the body. It becomes thicker and is too viscous and takes a lot more pressure to get around the body. The kidneys at the other end of the body need to maintain a certain pressure to be able to filter everything through them so they work to regulate the pressure. If the pressure is too low at the kidneys, other problems occur so the kidneys send a message to your heart to increase the pressure, even though this puts added pressure on the heart. In addition, the brain is a unique organ in that it cannot produce its own antioxidants like other tissues in the body can, and when the nutrients including antioxidants, oxygen and glucose it requires get low, it literally shuts down the function so that no damage occurs. As a result the brain also requires a constant flow of blood and if anything slows the flow of blood and nutrients it sends messages to increase the blood pressure. So high blood pressure, while it increases your risk of heart attack, is an essential function of the body to keep functioning as well as it can—not just your body gone wrong. Better to fix the things causing the high blood pressure than to just try to lower it.

Blood that’s too thick also slows the transport of essential nutrients, including oxygen, throughout your body. To help overcome this, drink more water (purified and re-mineralised). It is no coincidence that studies of tea drinkers around the world show those who consume more cups have lower levels of heart attack and stroke. It is not just antioxidants in the tea but also the large volume of liquids they drink.

Secondly, if the pipes in the garden are damaged in some way through oxidative damage from the sun, or if leaks or blockages occur, the pump has to increase pressure. In the case of our circulatory system, when damage to the arteries occurs, a plaque (atherosclerosis) forms as a nice soft flexible band-aid, along with the cholesterol and other ingredients, but it is the calcium that moves out of the blood to form a hardened plaque. Unless the damage is halted and reversed, damaged areas begin to thicken and harden (from the calcium), forming an atherosclerotic plaque and building up pressure.

Unlike the pipes in the garden, our arteries are flexible tubes surrounded by a layer of muscle. When the heart pumps the blood, the arteries expand to take the extra liquid and contract to help push the liquid along the arteries. If the muscles surrounding the arteries are rigid and cannot relax and function properly the arteries can’t expand and push the blood away from the heart, so the heart again has to pump harder and pressure builds.

The major reason for the arteries not relaxing is the damage done to a thin layer on the inside of your blood vessels called the endothelium. This single, very fragile one-cell layer sends messages by a chemical called nitric oxide (NO) to relax the arteries. If this layer, the endothelium, is damaged or doesn’t have the ingredients to produce NO, the arteries cannot relax. In healthy people the cells of blood vessels release NO, which instructs smooth muscles surrounding arteries to relax. In this manner blood vessels can release their constriction by themselves and lower blood pressure. With increasing arterial damage from plaque, high blood pressure, acidosis,oxidation and inflammation, the ability to produce NO declines. Simple. Many of the blood pressure drugs on the market, including Viagra, work on the same NO principle but nutrition does it better and much, much more safely.

More than 97% of high blood pressure is therefore caused by (1) not enough water in the pipes so the blood becomes too viscous, (2) damage to the arteries caused by poor nutrition and lifestyle and (3) the muscles around the arteries and arteries not being able to relax because of poor nutrition and lifestyle. To reverse high blood pressure all it takes is the nutrients required to repair and maintain healthy, flexible arteries and enough liquid by drinking adequate quantities of good clean water. At least this is what the research shows.

Studies have shown blood pressure lowered by 10 or 20 points in a few weeks or less of supplementing with just one nutritional ingredient or dietary and lifestyle changes without any medication. In support of this I have met hundreds of people who have lowered their blood pressure within a few days to weeks by changes in nutrition and lifestyle including drinking more water. Most telling though, I recently met a nutritional doctor friend of mine who had a patient come to her on five different drugs to lower blood pressure. Not only were the drugs not working but also the patient was having serious side effects common to these drugs. My friend put her on a very simple nutritional regime and was able to get her off all the drugs and lower her blood pressure within two weeks. Nutrition and lifestyle factors are the main cause of hypertension and atherosclerosis; it makes sense, therefore, that changes in these must surely reverse the condition. Another person, “EM,” had a blood pressure reading of 153 and was on two different medications but was having side effects. She adopted my blood pressure smoothie (see later) and over three weeks dropped to 123 mm Hg. Her energy levels were up and she felt much better than she had in years.

Unfortunately despite the effectiveness of diet and lifestyle changes the health system most often resorts to medication and puts the fear of god into you if you don’t take the drugs. While many antihypertensive drugs have proven results in decreasing blood pressure, they are not addressing the problem and that they have serious, even deadly, side effects including heart attack, Alzheimer’s and weight gain which then lead to many other complications. Furthermore, patients treated for high blood pressure with drugs still have a higher risk of heart attack and stroke compared to the average population unless these patients change their diet and lifestyle. Just one example, and I have book full of them, shows that beta blockers, which are one of the first choice medicines for hypertension and while undoubtedly effective at lowering blood pressure, actually increase cardiovascular mortality in doing so. So they stop one problem to create another. A meta analysis of 22 randomized controlled trials evaluating 34,096 patients taking beta blockers against 30,139 patients taking other antihypertensive agents and 3,987 patients receiving placebos found that the use of beta blockers to lower heart rate in hypertensive individuals increased the risk of cardiovascular events and death for patients (Bangalore et al. 2008, J Am Coll Cardiol. 2008; 52(18):1482-1489). The latest research on aspirin also shows the benefits have been exaggerated and the side effects kept quiet to the point where many researchers are now saying there is no benefit of taking aspirin and in fact there may be harm. By contrast, Pycnogenol, an extract from grapes, have shown it inhibits platelet aggregation as easily and effectively as would a five-times-larger dose of aspirin (Colman et al. 1999) as have many other nutrients.

Put simply what does work is increased levels of fruit, nuts, vegetables, beans, supplementation, sunlight and physical activity and stress less and avoiding toxins. Apart from these the best approach for those seriously wanting to reduce their blood pressure is Dr Dingle’s Blood Pressure Smoothie. The reason I call it the blood pressure smoothie is all of the ingredients have been multiple shown in scientific studies to reduce blood pressure. By no way is this meant to replace advice from you GP but you can share it with them and see if they are interested in preventing the problem rather than just treating it with pharmaceuticals. Remember also that I am not a GP I am just the guy who does all the research which is why I have a PhD.

4 ingredients in order of importance
Beetroot
Almonds (soaked for at least 8 hours)
Linseed (flaxseed)
Filtered re-mineralised ionized water. 

Extras for taste and minerals
Banana
Coconut
Dates 

You will remember earlier how NO relaxes the muscles surrounding the arteries and many of the beneficial actions of nutrition on lowering blood pressure results both directly and indirectly through improving endothelial tissue and NO production and release from this tissue. Two major pathways to increase NO are increase the rates of nitrates in the diet, the building block for NO, and L-Arginine which stimulate the enzyme to manufacture NO. A third mechanism that is absolutely critical is to protect and repair the endothelium, remember it is only one cell thick and very susceptible to damage. Vitamin C and antioxidants are essential for this part.

Diets high in dietary nitrate such as beetroot are associated with reduced blood pressure increased exercise performance as a result of vasodilation (expansion) of the blood vessels and a decreased incidence in cardiovascular disease. 100-200mg of beetroot per day has been shown to produce immediate effects of lowering blood pressure by around 15 mm of Hg. High levels of nitrate can be found in spinach, fennel, radishes, parsley, aubergine (eggplant), squash, broccoli, cabbage and kale, chard, cucumber, fennel, garlic and onions, kohlrabi, pumpkin, radishes (especially black radish), spinach, beans, celery, rhubarb, with the highest level, over 3,500 mg/kg found in lettuce, especially iceberg, cos, arugula (rocket).

Almonds have one of the highest sources of L-Arginine (most nuts have lots of L-Arginine so you can substitute the almonds if you want) which stimulates NO synthesis. Studies of almonds have shown reductions of 5-6 mm of blood pressure. It is important to soak the almonds as they (all nuts and seeds) have enzyme-inhibiting factors in them which stop them from germinating until they have enough water. Flaxseed is rich in Omega 3 fatty acids, L Arginine (about 20% less than almonds), lignans, antioxidants and fiber that together probably provide benefits to patients with cardiovascular disease. Studies on consuming 30g of flaxseed have been shown to reduce blood pressure by up to 15 mm Hg.

The great thing about this smoothie is that you can add just about anything else you want to it and it will make it even tastier and better for you. If you want to make up your own to add just a bit more “ump” or new taste sensation try these below.

Hundreds of studies have shown many other food ingredients to lower blood pressure including green tea which has been shown to reduce blood pressure by 4-5 mm. Flavanols found in cocoa have been shown to increase the formation of endothelial nitric oxide. The Greeks, Egyptians and Romans effectively used garlic to treat a host of ailments including infections, digestive problems, and high blood pressure. In a study of 210 Patients with hypertension supplementing with garlic showed significant decrease in blood pressure in both dose and duration dependent manner. In fact the garlic treated group outperformed the drug Atenolol (a selective β1 receptor antagonist and one of the most widely used beta blockers to lower blood pressure) and the placebo. But don’t tell your GP this they wont believe it.

Without any doubt supplementing with L Arginine, an amino acid, can have dramatic and rapid results in lowering blood pressure. Often many times better than any combination of drugs and it is available in many health food stores. Although you can get L Arginine in Almonds and other nuts you get a lot more and faster benefits by supplementing. One person I know had a drop of more than 25 mmHg in a few days from just using L Arginine. Then when they added the smoothie their doctor took them off their blood pressure medication. In a meta analysis of 29 randomized, controlled, clinical trials investigating vitamin C intake they found that taking an average of 500 milligrams of vitamin C daily reduced blood pressure by around 4 mmHg. Among those diagnosed with hypertension, the drop was nearly 5 mm and more vitamin C led to even lower levels of blood pressure. I have more than 5g of vitamin C each day. Quercetin supplementation also reduces blood pressure by around 7 mmHg. Lycopene, which the red you get in tomatoes reduces blood pressure by around 5 mm. Further analysis showed that supplementing with higher dosage of lycopene supplement (>12 mg/day) could lower blood pressure more significantly, especially for participants with higher blood pressure. Coenzyme Q10 lowers blood pressure and is particularly effective in reducing hypertension in diabetics and that it not only lowers blood pressure but also improves diabetic control. Supplementation with a marine pine bark extract for 8 weeks statistical significantly lowered systolic blood pressure. Almost 60% of the patients who supplemented with a marine pine bark extract were able to cut their prescribed medication dosage by half to keep their blood pressure in a healthy range. Amongst the minerals implicated in heart health via blood pressure lowering or improvements in vascular health are magnesium, potassium and selenium. A number of studies have also shown that probiotics also contribute to lower blood pressure.

It is very clear that by adopting my blood pressure smoothie and having lots of the nutrients I have mentioned throughout the day you can have a real impact on lowering blood pressure without drugs. Many of the studies on foods have shown that the foods are able to out perform the drugs and have no negative side effects, but are so good for you they help in many areas of health including lowering your risk of some cancers and other forms of disease.

In the words of Hippocrates the father of medicine some 2000 years ago.

“Let food be thy medicine”

and in my words “you can also supplement too to get an even better result”

 

Wednesday
Jul302014

Dental Fluorosis

Dental fluorosis is a serious condition that affects the growth and development of tooth enamel, particularly in younger children. It is characterised by an increased porosity of the tooth enamel, coupled with visible discolouration (colouration can vary from small white spots to large brown and black stains) (Fomon. 2000). In severe cases fluorosis can lead to an extensive increase in the fragility of the teeth (leading to chipping, fracturing and pitting) and decay. In 2005 32% of American children (Australian data was unavailable) were diagnosed with mild cases of fluorosis (CDC. 2005). A study by the Ontario Ministry of Health and Long Term Care found that the rates of fluorosis in fluoridated communities were significantly higher than the rates from non-fluoridated communities, indicating that excess consumption of fluoride via water fluoridation was having a direct effect on dental health (Locker. 2005). 

 

The biology of dental fluorosis suggests that fluoride hinders the healthy development of tooth enamel by interfering with the mineralization (enamel ‘building’) process of growing teeth (Fejerskov et al. 1996). When a tooth is developing in a child’s gum a complex matrix of enamel rods (which will eventually become the outer layer of the tooth) is created (DenBesten. 2002). The building of these matrixes is organized by the protein known as amelogenin (Fejerskov et al. 1996). Typically, once the enamel matrixes have been formed, the amelogenin is broken down by a protease (enzyme that breaks down proteins), leaving room from the full mineralization of the tooth enamel (Aoba & Fejerskov. 2002). However, studies have demonstrated that fluoride interferes with the protease activity and inhibits the enzyme from breaking down all of the amelogenin (ATSDR. 2003). Therefore, following mineralization where the enamel matrixes are mineralized by calcium crystals to produce completely formed enamel, a tooth which has been exposed to fluoride will appear porous, due to the retention of amelogenin and the incomplete mineralization of the enamel (DenBesten. 2002). However, teeth are not the only body part susceptible to the toxic effect of fluoride, skeletal fluorosis is another emerging health condition related to excess consumption of fluoride.